Braintaining : Lifelong feeding and care of an agile, healthy mind

The brain is highly dynamic, always reorganizing, and it can be shaped — for good or for bad.—Dr. Paul Nussbaum

ALBUQUERQUE, N.M. — Jane Blume was part way down a building, rappelling for charity, when her exhausted body temporarily gave out. She dangled briefly, resting. At 70, she pushes her limits — she takes dance classes, volunteers, runs a public relations firm and is rehearsing for a flash mob. She walks at least a mile a day.

Her full life is also one of preventive braintenance — providing feeding and care to her brain so it stays as agile and healthy as possible.

Brain care should be a "lifespan issue, from womb to last breath," said Dr. Paul Nussbaum, chairman of the Alzheimer's Foundation of America's Prevention Advisory Board, clinical neuropsychologist and founder and president of the Brain Health Center, opening in Pittsburgh this fall. "The brain is highly dynamic, always reorganizing, and it can be shaped — for good or for bad."

While even youngsters know they need to exercise, eat well and stay fit to be healthy, helping the brain is often overlooked, said Alvaro Fernandez, co-author and CEO of "The SharpBrains Guide to Brain Fitness," a market research firm that tracks brain science.

Those physical things are crucial to brain health. But the brain needs more. It wants to be challenged and entertained, amused and frustrated, soothed and loved. A healthy brain lifestyle, said Nussbaum, covers five bases — nutrition, physical activity, mental stimulation, socialization and spirituality.

Work in progress

Not all efforts at improving brain health are created equal; there are critics and advocates galore. Individual programs that claim results may be inconsistent in quality and result. "Some work well, some are a joke," Fernandez said.

Still, no one disputes the brain can be improved at any age, even with dementia. Putting in as little as 20 hours can help. Evidence is so compelling, some schools offer students working-memory and brain-targeted programs, Fernandez said. AARP in some states has a program to improve cognitive abilities for safe driving, which decline after 50. It's becoming well-accepted that Alzheimer's symptoms may be delayed, Fernandez said. Stimulating development of lots of neurons provides some protection.

Brain health has spawned an industry, from companies like Fit Brains and Lumosity that offer games and exercises to stimulate the brain to books on staying or getting sharp. Many are written by researchers, programs often designed with universities.

Lumosity's vice president of research and development, Joe Hardy, said his company has 38 university-based research collaborations at top universities and has amassed "an enormous database of human cognitive performance, the result of having 40 million-plus users on our site."

Concern about maintaining mental agility has never been greater, fueled in part by the fact that a huge segment of the population, baby boomers, are now in or entering their senior years. At the same time, more than 5 million Americans have Alzheimer's disease and one-third of Americans will die with it or another dementia. It's a huge financial and emotional toll on individuals and families. At the same time, medicine now allows people to live longer with various conditions that would otherwise have killed them, so maintaining mental fitness is crucial. That need to stay sharp is one reason Blume found herself dangling off a building; she saw her father, a physician, retire and decline rapidly.

The database has not only helped Lumosity figure out how the brain works and which exercises help, but tasks and times. They know intense concentration is easier in the morning, creative tasks best done after noon for most. As the evening passes, "performance of every type drops off. Midnight is the low point."

Mix it up

Building up the brain requires novelty, effort and challenge.

A first crossword or other puzzle probably did great things for your brain. If you can now zip through, the effect diminishes. Fernandez likened a 100th crossword puzzle to only exercising your right bicep. People who have struggled with and mastered a task must move on to other challenges to reap brain-enhancing benefits.

Scientists also know a lot about what tears a brain down — poor nutrition, stress, physical stress, disordered sleep, even dehydration.

One goal is to make the brain adaptive so you can take what you learn in one situation and apply it to another, said Phillip Tomporowski, a professor of kinesiology at the University of Mississippi who just co-wrote the second edition of "Exercise Psychology."

When researchers did a major review of interventions two years ago, physical activity — good old exercise — consistently provided long-term benefits for the executive functions, which include planning, keeping things in memory and adapting. "That's not to say it's a cure-all, but it shows more of an effect than computer-based mental games," Tomporowski said.

Good health and lifestyle habits matter. For instance, habitual running helps the brain. Variety in where you run, how fast and with whom boosts the impact, he said.

Physical exercise helps every age, starting with children's brain development. The impact is not just from moving, Tomporowski said, but moving with intention. "When it gets repetitive, it needs to be changed." He said kids are built to move in "bursts of activity." They benefit from games that are "intrinsically interesting and motivating." Loving physical activity can build strong brains as a lifelong process.

Mental stimulation

Not everyone's convinced all online games and puzzles touted as brain builders work. Still, Susan Krauss Whitbourne, a psychology professor who directs the Office of National Scholarship Advisement at the University of Massachusetts Amherst, said games and video games "absolutely can make a difference." Some claim only first-person shooters are effective. She and colleagues found that even games as gentle as mah-jongg had a small benefit for the brain. Some games provide social connection, also important to brain health.

Young people have opportunity to counter things that weaken the brain, Whitbourne said. "A job that has a high degree of engagement will keep your intellectual function in better shape, whether there's a lot of complexity, decision-making, a certain amount of autonomy." If your job's not like that, find leisure activities that provide what's missing.

Cognitive strengths come from a mix of executive functions, like being able to think and plan, speed and mental agility. Knowledge is something you get from exposure to information, like reading a newspaper. There are different aspects to intelligence. You need a diet of mental exercises, said Whitbourne, who writes a blog on PsychToday.com.

Researchers seek many ways to help the brain stay healthy. A recent clinical trial at Beth Israel Deaconess Medical Center tested the NeuroAD medical device. It uses non-invasive electromagnetic stimulation of the brain along with cognitive training on a computer. The stimulation and the exercises together target specific brain regions affected by neurodegeneration. It agreed with trials in Israel that showed significant cognitive improvements.

Slipping?

Folks worry every memory slip spells disaster, Whitbourne said, but everyone has lapses. Instead, focus on keeping your mental abilities sharp. Since even those with severe dementia can improve, it's a good idea to never give up, she said.

Several experts described autopsies that clearly showed the shrunken brain, amlyoid plaques and ragged tissue left by Alzheimer's in individuals who didn't have a single symptom. You can delay the disease's effects.

Helen Mendes Love, 78, from Humble, Texas, knows stress and anxiety are bad for the brain. "Instead of worrying about money, or my health is going to be bad, I pray and trust God, and that puts less stress on my brain." Research confirms that approach. Prayer and meditation have significant stress-reducing properties, helping the brain.

She taught social work at the University of Southern California and directed social work for undergrads at Pepperdine and knows memory is enhanced when you care about what you need to remember, she said. She eats well for health and to show respect for God. When she reads about a problem, she considers how she can address it. She could not help the children massacred in Newtown, Conn., or the young man who killed them, by all accounts a disturbed, isolated person. She challenged her seniors church group to identify people in their environment who appear lonely and think through how to help them.

"When we are engaged with others, we stay more involved in life, and that affects our brain." She watches "Jeopardy" with her husband. If there's a TV whodunit, they debate who committed the crime. She learned French and some Spanish as a brain exercise, too. That helps when she travels — and travel is brain-friendly, too.

Mental muscle

Fernandez said he would bypass supplements and focus on building neurons. Forceful exercise, like fast walking and climbing stairs, all enhance the rate at which neurons form.

Then, they must be stimulated or they'll die. The key is mental and physical exercise that brings into play elements of novelty, variety and challenge. With that, neurons can survive for years, Fernandez said.

While stress can boost alertness and focus, too much thwarts neuron creation. If you're stressed for the 10 minutes each day it takes to get the kids off to school, it's no big deal. If you are stressed for weeks and months, it damages the brain. Taking a memory class will be much less helpful than learning meditations or yoga or biofeedback to regulate stress, Fernandez said.

While scientists search for a cure for degenerative illnesses like Alzheimer's, people can improve outcomes now. Learn new things. If they're hard, great. If you have no aptitude, keep working on it, experts said. The struggle may offer the greatest benefit.

Fernandez emphasized that lifestyle has more impact than genetics. Stay challenged, look for novelty and choose diverse activities. Your brain will thank you.